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STI treatment guidelines

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STI

PREFERRED TREATMENT – TREATMENT CONDITIONS

FOLLOW-UP

RECOMMENDED REGIMEN

PREGNANCY REGIMEN

PENICILLIN ALLERGY

CHLAMYDIA

Azithromycin 1 g PO in
single dose if poor compliance is
expected
OR
Doxycycline 100 mg PO bid for 7
days
ALTERNATIVE
Ofloxacin 300 mg PO bid for 7 days
OR
Erythromycin 2 g/day PO in divided
doses for 7 days
OR
Erythromycin 1 g/day PO in divided
doses for 14 days

Azithromycin 1 g PO in a
single dose if poor compliance
is expected
OR
Amoxicillin 500 mg PO
tid for 7 days
OR
Erythromycin 2 g/day
PO in divided doses for
7 days
OR
Erythromycin 1 g/day PO
in divided doses for 14
days

Same as recommeded
treatment regimen.

Test of cure should be
performed 3-4 weeks
after treatment for all
pregnant women and
nursing mothers who
have used erythromycin
or amoxicillin.
All other clients only
require a 6 month
repeat test.

GONORRHEA
All patients treated for gonorrhea should also be treated for
chlamydial infection, unless a chlamydia test result is available and
negative.

Cefixime 400 mg PO in a single dose
OR
Ciprofloxacin 500 mg PO in a single
dose (unless not recommended due
to quinolone resistance)
OR
Ofloxacin 400 mg PO in a single dose
(unless not recommended due to quinolone
resistance)
OR
· Ceftriaxone 125 mg IM in a single
dose

Cefixime 400 mg orally in
a single dose
OR
Ceftriaxone 125 mg IM in
a single dose
OR
Spectinomycin 2 g IM in a
single dose

Azithromycin 2 g PO in
a single dose
OR
Spectinomycin 2 g IM
in a single dose

Culture 4-5 days post
treatment if:
Alternative treatment
used (especially
if Ciprofloxacin
is used)
Compliance
uncertain
Pharyngeal/Rectal
If a urine test (NAAT)
is used for follow up
testing instead of a
swab, delay specimen
collection for 3 weeks
post treatment

PID

Regimen A:
Ceftriaxone 250mg IM in a single
dose PLUS doxycycline 100mg PO
bid for 14 days
OR
Cefoxitin 2g IM PLUS probenecid
1g PO in a single dose concurrently
once PLUS doxycycline 100mg PO
bid for 14 days
Many authorities recommend the
addition of metronidazole 500mg
PO bid for 14 days to this regimen
for additional anaerobic coverage
and treatment of bacterial vaginosis
Regimen B:
Ofloxacin 400mg PO bid for 14 days
PLUS/MINUS metronidazole 500mg
PO bid for 14 days
OR
Levofloxacin 500mg PO qd PLUS/
MINUS metronidazole 500mg PO
bid for 14 days

Pregnant women with
suspected PID should be
hospitalized for evaluation

 

Individuals receiving
outpatient therapy
should be re-evaluated
2-3 days after
treatment has been
initiated. If no clinical
improvement, hospital
admission is required.

EPIDIDYMITIS

Doxycycline 100 mg PO bid for
10-14 days
PLUS
Ceftriaxone 250 mg IM in a single
dose
OR
Ciprofloxacin 500 mg PO in a single
dose (unless not recommended
due to quinolone resistence)

 

Azithromycin 2 g PO in
a single dose

Retest post treatment
if compliance is uncertain
or if alternative
treatment is used.

SYPHILIS

Primary, secondary, early latent, less
than 1 year
duration:
Benzathine Penicillin G 2.4 million U
IM in a single session
Late latent, more than 1 year of indeterminate
duration:
Benzathine Penicillin G 2.4 million
U IM once/week for 3 successive
weeks (Call the Sexual Health Clinic to
obtain)

Primary, secondary, early
latent:
Benzathine Penicillan G 2.4
million units IM weekly for
1-2 doses
There is no satisfactory
alternative to penicillin for
the treatment of syphilis in
pregnancy; strongly consider
penicillin desensitization
followed by treatment with
penicillin
Late Latent:
Benzathine Penicillin G 2.4
million units IM weekly for
3 doses

Strongly consider penicillin
desensitization.
Primary, secondary, early
latent:
Doxycycline 100 mg PO
bid for 14 days
Ceftriaxone 1g IV or IM
daily for 10 days
Late Latent:
Doxycycline 100 mg PO
bid for 28 days
Ceftriaxone 1g IV or IM
daily for 10 days

For primary, secondary
and early latent:
repeat serology at 1,
3, 6, and 12 months
after treatment.
For late latent:
repeat serology 12
and 24 months after
treatment.

LGV
Lymphogranuloma venerum)

Doxycycline 100 mg PO bid for 21
days
ALTERNATIVE
Erythromycin 500 mg PO qid for
21 days
Possibly, Azithromycin
1 g PO once weekly for
3 weeks

Erythromycin base 500
mg orally 4 times a day x
21 days
Azithromycin 1 g orally
for 3 weeks (may be
effective, but not proven)

Erythromycin base 500
mg orally four times
a day x 21 days (DO
NOT use estolate formulation
in pregnancy)

Test of cure should be
repeated until tests
are negative and patient
has recovered.

Adapted with permission from Niagara Region Public Health Department, Halton Region Health Department and from the 2008 STD (Canadian) Guidelines Updated Jan 2010.

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